Interview with Dr Hanna Tolonen (Finnish Institute for Health and Welfare)
In the framework of the EHFG 2019 workshop on ‘Facts. Figures! Fiction?’ Hanna Tolonen introduced the EU-funded INFACT project, which attempts to streamline health information activities across Europe. I spoke with her about the challenges of establishing sustainable systems in the age of technological revolution, priorities of European public health, and key lessons Young Gasteiners should take away from the European Health Forum Gastein.
MZ: It was great to learn from you about the challenges you face in Finland when it comes to data integration and also about the research infrastructure initiative prepared by the INFACT project. Could you tell me a little bit more about what was the inspiration behind this work?
HT: INFACT is a continuation of work we have been doing for the past 10-15 years in Europe, first within separate projects, and then under an umbrella project. Initially, there were many isolated, individual projects on health information. Then, in 2015 the BRIDGE Health project was set up. Its intention was to pool together several of those existing smaller initiatives on injuries, perinatal care, and so forth which had a lot of common features on the data side..
The BRIDGE Health project focusses on the idea of establishing a shared, sustainable system for health information in Europe. This led us to the INFACT project and a concrete proposal for the infrastructure that needs to be established to achieve this goal. We are now aiming for the European Strategy Forum on Research Infrastructures (ESFRI) roadmap, which we will be updating next year. This is the next step to get this research infrastructure more formalised, and then step by step start building the actual infrastructure.
MZ: Do you have an idea for the timeline of the INFACT project? How many years are we looking at for it to become reality?
HT: Well, I would say that with some good luck, if everything goes smoothly, within five years we should have certain steps already in place. However, ten years might be the timeline within which the infrastructure becomes fully functional, with all the components we can see at this stage. Obviously, the world is changing quite fast – just look at developments in Big Data, artificial intelligence, and things like that. While we start working on establishing the infrastructure in one way, we might need to re-direct it at some stage in the future. We should therefore look at it as an ongoing process that will be evolving over the years.
MZ: You talked about the vast differences in estimates of obesity rates in Finland as an example of how various data sources can yield completely different results. Could you mention some other examples of this?
HT: On the health side you have hypertension, where you also see a variety of results. When you go to see a doctor, they might measure hypertension or not, but hypertension medication is also used as primary prevention among diabetics and for people who have other diseases. Obtaining reliable information on the prevalence of hypertension from the register is very difficult, so to measure it you actually need to examine people. We know that approximately one-third of the people who are hypertensive do not actually know they have elevated blood pressure. This is the case in Finland, but it is also true for Europe more generally. As hypertension can be asymptomatic many hypertensive people end up not seeking any medical help.
MZ: What have been the highlights of the Gastein Forum for you this far?
HT: I really enjoyed the session on big data this morning [‘When epidemiology meets Big Data’, organised by ECDC], especially the message that while there is a lot of data out there, it is rarely complete. We need to validate also the registered base data to identify the gaps in data quality and coverage. That is something we have been doing a lot of in Finland, where we can do direct linkage to the survey data and administrative data.
I also liked the session on health inequalities [‘Changing the game on health inequalities’, organised by WHO Euro]. It raised the issue that health inequalities are not only related to health and healthcare, they are tightly intertwined with economic considerations, housing, and many other issues which can be easily neglected with our traditional approaches to health. We have started looking at socioeconomic patterns behind inequalities, but we are not digging deep enough to understand what their root causes are.
MZ: How useful do you find the frame of ‘disruption’ that has dominated the Gastein Forum this year?
HT: I think it is useful and it is generating good discussions. It is not straightforward, and it therefore allows for new ideas to be explored.
MZ: One final question – what would be the main message you would like the Young Gasteiners to take away from this year’s meeting?
HT: Step out of your own comfort zone and take a broader perspective on health – environmental determinants, social determinants, financial determinants, and the many other angles that exist out there. Take a more holistic approach to your work!
This interview was conducted by a Young Gasteiner Mateusz Zatonski, University of Bath (UK) and Health Promotion Foundation (Poland)